Primary Retinal Detachment
Primary Retinal Detachment
Primary Retinal Detachment
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168<br />
Inadequate Training<br />
Vitrectomy is being increasingly employed for primary retinal detachments<br />
because the number of doctors trained to do vitrectomy<br />
has markedly increased in the past decade, as have the indications<br />
for vitrectomy. In addition to the original indications, traction detachment<br />
in the diabetic eye and PVR after failed retinal surgery,<br />
vitrectomy is done for macular holes, macular puckers, dropped<br />
lens and particles, to clear vitreous hemorrhage, and, more recently,<br />
to dissect subretinal proliferative lesions in the macula. The indications<br />
keep expanding. <strong>Retinal</strong> detachment can be a relatively<br />
infrequent indication for operation on a busy retinal service and of<br />
secondary interest. As a result, training for the treatment of retinal<br />
detachment may be limited. There are few opportunities outside of<br />
the fellowship to learn about buckling. <strong>Retinal</strong> programs rarely<br />
include papers on the subject; it has all been said. Except for<br />
William Mieler’s short course at the Academy and Ingrid Kreissig’s<br />
<strong>Retinal</strong> <strong>Detachment</strong> Courses at various national and international<br />
meetings, there are no workshops on the art of scleral buckling.<br />
As a consequence, the coming generation of retinal surgeons may<br />
not be very skillful at performing a scleral buckle. In another<br />
decade, it is possible that the buckling operation will have become<br />
a lost art.<br />
Market Forces<br />
8 Systematic Review of Efficacy and Safety of Surgery<br />
Preparation for a segmental buckle operation can require much<br />
study time, frequently hours and sometimes days. A decade ago, if<br />
the senior author (HL) could not find a break that promised a 90%<br />
prognosis after an hour’s study, he would patch both eyes, put the<br />
patient at rest, and re-study the eye the next day. Most detachments<br />
change with ocular rest, and the change is informative. Today, the<br />
insurance companies and Medicare do not allow for an extra day,<br />
nor is there payment for study time. It is more expedient to do a